Project Summary Fertility is very important to many young women diagnosed with cancer. Surgery, chemotherapy, and radiotherapy can impact fertility and pregnancy outcomes. Conversely, pregnancy at the time of cancer diagnosis or after cancer treatment can impact survival. Despite the increasing number of young women with gynecological or breast cancer and the importance of accurate information in guiding counseling, evidence regarding the impact of pregnancy or assisted reproductive technologies (ART) on oncological and obstetrical outcomes following cancer treatment remains limited. To address these knowledge gaps, Dr. Rauh-Hain plans to conduct a population-based observational study to estimate fertility, obstetrical, and oncological outcomes in women age 18?45 years who are diagnosed with early-stage ovarian, uterine, cervical, or breast cancer and opt for fertility-sparing oncologic treatment. We propose a novel linkage of four unique data sources: 1) California Cancer Registry (CCR) data, which include information about tumor characteristics, primary cancer- directed therapy, and survival for all cancer cases diagnosed in California; 2) California Office of Statewide Health Planning and Development (OSHPD) Birth Data, which include maternal antepartum and postpartum hospital records for the 9 months prior to and 1 year after delivery; 3) California OSHPD inpatient and ambulatory surgery discharge data sets, which contain patient treatment data for all inpatient and ambulatory surgeries; and 4) the Centers for Disease Control and Prevention (CDC) National Assisted Reproductive Technologies (ART) Surveillance System data set, which includes all ART cycles initiated in U.S. fertility clinics. We will supplement these data with a cross-sectional survey to identify barriers preventing reproductive-age women from achieving successful pregnancies. This study will provide information about oncological, fertility, and obstetrical outcomes among women who become pregnant or underwent ART after a gynecological or breast cancer diagnosis and identify barriers that prevent reproductive-age women from achieving successful pregnancies leading to a live birth. Dr. Rauh-Hain is a gynecologic oncologist and health services researcher at The University of Texas MD Anderson Cancer Center. He has a particular interest in understanding the quality of care for reproductive-age women with cancer. His long-term career goal is to become an innovative and independently funded health services and comparative effectiveness researcher in gynecological cancer. The research program described here is designed to complement a career development plan that includes training in advanced statistical modeling and survey design and implementation. This award will lay the foundation for two follow-up studies: 1) a prospective multicenter cohort study to assess barriers to, and decision-making regarding, future pregnancies in this population and 2) the use of the linked databases to expand the study to a broader population of reproductive-age women with common cancers.